The Foglight - The Roles We Play Part 1: The Angry One, the Panicker, and the Supporter – Adults In Their Families of Origin During a Medical Crisis

April 2025

Issue 22: April 2025 

In This Issue: In part one we explore three of the five family roles I’ve noticed that adults take on during a prolonged medical crisis. This issue covers the Angry One, the Panicker, and the Supporter —and how these roles impact families under stress. Part two will cover the Leader and the Disengaged One.

The Roles We Play: The Angry One, the Panicker, and the Supporter – Adults In Their Families of Origin During a Medical Crisis, Part 1

With my mother’s passing and the multiyear illness that led up to it, one of the unexpected outcomes was a deep strain in my previously close relationship with my brother. This strain has caused me to reflect on how a protracted illness of an family member can change the relationships and roles of the adult children, each of whom may now have their own families. In my five years helping families navigate the medical system, I have noticed how, when a family is in the midst of a protracted medical crisis, the adult members of what once was a nuclear family of two parents and their children start to play certain “roles.”  

As my loyal readers know, I am not a psychologist, just a humble medical doctor now working as a private patient advocate. The ideas of different roles played by different people will be familiar to anyone who has done family-systems therapy: in the family-systems model, family members play parts that help maintain the family’s emotional balance—or imbalance. For example, one family member may be the “hero,” over-achieving and self-sacrificing; another may be the “scapegoat,” the bad one, who gets blamed for the family’s problems. These models, however, are usually applied to nuclear families. I’m thinking about the roles I’ve repeatedly seen played by adult children and their parents during times of stress.  

I have come up with the following roles. Sometimes, individuals shift between these roles. Sometimes, they stay locked in one role. The roles are the Angry One; the Panicker; the Supporter; the Leader; and the Disengaged One. Each seems to serve its own purpose for the person in it. They are all roles into which people can take refuge when a family member’s health crisis stresses the whole family. In this post, I will discuss the first three of these roles, saving my discussion of the Leader and the Disengaged One for next month’s post. 

 To begin, the Angry One finds fault, sometimes with the wrong things. He blames people and lashes out. In his anger, he distorts facts and sees others as having sinister motivations when the real culprit is bad luck, miscommunication, or garden-variety incompetence. Sometimes he blames a family member, sometimes a doctor, or sometimes a staff member. His anger can be explosive and destructive. When aimed at doctors, the anger can get him thrown out of the hospital or cause any further input from him to be completely disregarded. I’ve noticed that when the Angry One is a person of color, he is especially at risk of being banished or disregarded by the doctors. 

For example, I worked for one Black family in which the son and a daughter, both thoughtful, caring academics, needed my help with their seriously ill father. By the time I was involved, the son had already blown up at the doctors on several occasions, to the point where only his sister was communicating with the medical team. I don’t know exactly what had happened, but I did know that the hospital’s response to their current inquiries was ridiculous. Their father was on a ventilator and extremely anemic, with a hemoglobin under 5. A healthy hemoglobin level is above 13. Hemoglobin carries oxygen to your body; it’s necessary for one to live. Most hospitals will do a blood transfusion when hemoglobin drops below 8. I coached the daughter to ask when the hospital would give him a transfusion. The answer can back “Under 4”. Umm, nope—that is bad medicine. This family had been shut down and dismissed. And Dad was suffering for it.  

In another family, the Angry One was a daughter who surfed the internet and used disjointed fragments of information to challenge the doctors’ treatment or diagnostic decisions. Based on her web surfing, she would angrily demand that the doctors order inappropriate tests or prescribe certain medications. She hired me after the doctors stopped returning her calls. The doctors were happy to talk to me, and I acted as a go-between. Fortunately, she could trust the information I gave her, and she did calm down and made better decisions. 

  The Panicker (whom I sometimes think of as the “overwhelmed panicker”) worries about the wrong things, makes a stink, yells or cries, and can be paralyzed by emotion. He can spend a lot of time going down pointless rabbit holes. Sometimes, others perceive the Panicker as attention-seeking. 

For example, I had one family with a seriously ill loved one, also on a ventilator, as it happens, and the Panicker was completely focused on getting Mom’s hair washed. The Panicker repeatedly and vehemently complained about the state of her hair. While I agreed that having her hair done would be nice and soothing, I thought other activities, such as moving Mom’s limbs to prevent contracture, were more critical. The doctors sometimes avoided going in the room if the Panicker was there.  

The Supporter has boundary issues. Often, she has been the main provider of long-term emotional support for the sick person, and she tries to be kind by doing whatever the sick person asks. The Supporter can be tremendously helpful: she’s the person the sick person turns to time and time again. Sometimes, the Supporter is good at calming down other angry or overwhelmed relatives; sometimes, she can reengage others who have checked out. But she can also over-indulge the sick person, providing too much support. Family members may think she’s enabling the sick person, making them worse. She seems to carry the emotional weight of everyone, and she suffers for it. 

One Supporter and his mother called me at 3 a.m. because Mom was having an increase in her ongoing symptoms and wanted to go to the emergency room. The issue in the Supporter’s mind wasn’t Should Mom go to the ER?, but rather Which ER should Mom go to? After we discussed the pros and cons of seeking care in the middle of the night, they decided to wait until morning. In the morning, her symptoms were back to her baseline, and Mom no longer wanted to go the ER. It was clear to me that the Supporter was planning to turn his life upside down to do whatever Mom wanted without question.  

Another Supporter worried about her dad, as well as all the other family members, called around to each of them, constantly trying to be sure they were okay. She wasn’t sleeping, and she spent so much time taking care of others that she had stopped exercising and was feeling exhausted and unwell.

In the next issue of The Foglight, I will round out this portrait of different family roles by discussing the Leader and the Disengaged One. In the meantime, drop me a line if you have noticed any of these roles being played out in your own family—or if you have ideas for other roles that I may not have thought of. I appreciate reading your thoughts and ideas.

Email me with your questions, comments, or subscription requests at gerda@mymdadvisor.com. I’d love to hear from you.

Wishing you peace and understanding in your healthcare journey,  

Gerda Maissel, MD, BCPA

Dr. Gerda Maissel, Author

Dr. Maissel is a Board-Certified Physical Medicine and Rehabilitation physician and a Board-Certified Patient Advocate.